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Eur J Cardiothorac Surg 2003;23:254-255
© 2003 Elsevier Science NL

Letter to the Editor

Reply to Spaggiari et al.

Department of Thoracic and Cardiovascular Surgery, Saga Medical School, 5-1-1 Nabeshima, Saga City 849-8501, Japan

Received 18 October 2002; accepted 21 October 2002.

* Tel.: +81-952-342345; fax: +81-952-342061
e-mail: sakurat{at}post.saga-med.ac.jp

Key Words: Mediastinal carcinoid tumor • Thymic tumor • Neuroendocrine thymic tumor • Chemotherapy

The author would like to thank Spaggiari and coworkers for their comments regarding their experience with induction chemotherapy for this rare disease. Indeed, there is very little evidence of the strategy in the worldwide literature. I strongly support their opinions regarding treatment of this tumor.

We have a positive impression of chemotherapy and radiotherapy in the control of this tumor. In our case [1], there was a local recurrence of the tumor 2 years after the last operation on the thorax (right upper lobe of the lung, right pulmonary hilum, and behind the sternum). Surgical resection was not indicated because a right pneumonectomy under permanent left phrenic paralysis would have been necessary for a complete resection. Concurrent chemoradiotherapy using cisplatin (10 mg)+5-FU (50 mg) twice a week for 1 month (irradiation 66 Gy totally) was effective and the patient is doing well 1.5 years after treatment and 16 years after the primary operation.

I would like to emphasize the importance of long-term follow up of the patient with this tumor. In our case, the first local recurrence was seen 5 years after the primary operation followed by prophylactic adjuvant chemotherapy. In recent reports, Tsuchida et al. [2] described one long-term survivor of this tumor who had a recurrence 6 years after the primary operation and another who had a recurrence 8 years after the primary operation. It would be suggested that this tumor is malignant but slow-moving. Body CT scanning is required for long-term postoperative follow-up to find small tumor recurrences and it would be concluded in the early surgical intervention.

In conclusion, because this is a rare tumor, it is very difficult to collect evidence for appropriate treatment in a prospective study. As thoracic oncologists, it is our responsibility to report our experiences with these cases on a global scale.

References

1. Sakuragi T., Rikitake K., Natsuaki M., Itoh T. Complete resection of recurrent thymic carcinoid using cardiopulmonary bypass. Eur J Cardiothorac Surg 2002;21:152-154.[Abstract/Free Full Text]
2. Tsuchida M., Yamamoto Y., Hashimoto T., Saito M., Ayashi J. Recurrent thymic carcinoid tumor in the pleural cavity. 2 cases of long-term survivors. Jpn J Thorac Cardiovasc Surg 2001;49:666-668.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sakuragi, T. Search for Related Content PubMed Articles by Sakuragi, T. Related Collections Mediastinum